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Brevard County dermatologist helps couples spot skin cancer early

By Susan Jenks, Florida Today

1164 days ago   Article ID# 876477
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Skin Care Foundation

MELBOURNE, FLORIDA (Florida Today) - His and her skin cancer checks may not sound like the stuff of romance, but the idea could save lives.

Timed for a pre-Valentine's Day rollout, the "couples initiative" teaches spouses and significant others to recognize suspicious lesions on each other's skin, such as dark-chocolate-colored moles, or patchy red spots that fail to heal, and checking them out at least once a month.

"The hope is to diagnose skin cancers earlier," said Dr. Anita Saluja, the Melbourne dermatologist who came up with the idea. "I advise every patient to do a monthly skin check at home. With a partner, that becomes much easier."

Saluja would get no argument from Melbourne residents John and Andrea Hogan, avid boaters who spend long hours in the sun and who've already seen the DNA damage the sun's ultraviolet rays can cause.

Andrea's had two bouts with early melanoma, the deadliest type of skin cancer, she said. Her husband's been treated for slower-growing nonmelanoma skin cancers, which can be disfiguring, but are highly curable and the most common cancers in the United States, according to the American Cancer Society.

"I've had a lot of stuff cut off my head," he said, referring to both basal cell and the more-aggressive squamous cell carcinomas. Also he's undergone blue-light therapy, a low-intensity light activated by a topical chemical, to disrupt skin cancer's development.

"It lasts 16 minutes and 40 seconds," he said, describing the pain and discomfort of the procedure. "If you don't have a fan cooling you off, there's no way you can sit there and take it."

The Hogans, both barely 60, have been patients of Saluja's since retiring in Brevard County in 2006. They said they find her idea that they come in together for skin cancer screening convenient and helpful. And so far, they've been clearly satisfied with their care.

In Andrea's case, she said, when a second melanoma developed on her back, Saluja caught it early enough to treat it in her office, whereas the first melanoma, treated in Virginia where the couple lived at the time, required hospitalization and anesthesia, creating a sizable scar.

The earlier melanoma probably had penetrated more deeply into the skin, Saluja suggested, or ulcerated -- two reasons dermatologists might refer patients for further evaluation and potential surgery.

Although melanomas account for only 5 percent of skin cancers, these cancers, which arise in the pigment producing melanocyte cells, are responsible for 75 percent of all skin-cancer deaths, according to the national Skin Care Foundation. That high lethality is behind an ongoing push nationally by the American Academy of Dermatology and other medical groups to alert individuals to changes in their moles or new growths that might signal a developing melanoma. Defined as the "ABCDs" of melanoma, these familiar red flags include:

Asymmetry, meaning one half of the mole is unlike the other.

Border irregularity, or scalloped, poorly defined edges.

Color variation from one area to the other.

Diameter larger than 6 mm, or the size of a pencil eraser.

But, recently, the academy added another letter, "E," for evolution, to reflect the dynamic nature of this malignancy and physicians' increasing knowledge about how it may develop.

"Diameter is not as important as it used to be because melanomas can be very small," Saluja said. "We look more today for changes in size, which we call evolution or evolving."

The "E" factor captures "if a mole changes over time," agreed Dr. Terrence Cronin Jr., another Melbourne dermatologist and a former president of the Florida Society of Dermatologic Surgeons. "And if it bleeds, we're really worried."

'Getting worse'

Of Saluja's idea for couples' skin screenings, Cronin was complimentary.

"I think anything that shines a light on this epidemic is great," he said. "We all know it's getting worse," especially for nonmelanomas. Experts estimate these skin cancers affect more than 2.8 million Americans each year, and possibly more, as doctors are not required to report these cancers to cancer registries.

As for melanoma, Cronin said in his practice, he sees an average of one new melanoma patient every week, and there's no sign this steady stream of patients is weakening.

"There are at least 13 dermatologists in town, and we're all busy," Cronin said.

In Saluja's informal skin tutorials -- usually delivered by staff -- patients are told to watch out for "Pacman-shaped" moles or "ugly ducklings" that stand alone in a crowd of lesions and moles.

"If you find a matching mole, that's a good thing," she said. "The ugly ducklings are the problem."

Also she said, she circles suspicious lesions with a magic marker, as an extra precaution, before sending patients home. "It lets patients know these are the things they need to watch closely," she said.

His, hers detection
Surprisingly, men and women have different detection skills, according to several studies.

Women appear more sensitive to detecting color changes in moles, Saluja said, while men do better picking up irregularities in shape.

"We hope to use the strength of both for early detection," she said.

Given their skin cancer histories, the Hogans have few doubts their combined efforts will help keep future cancers under control, especially in places that are difficult to see.

And, John Hogan jokes, there's probably another benefit, as well.

"The couple who checks their skins together stays together," he said.

Copyright 2014 Florida Today   (Copyright Terms)
Updated 1164 days ago   Article ID# 876477

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